C.H.I.R.ONE: Probes for radio-guided surgery

video of scan on small bowel GEP-NETSurgery plays a primary role in the field of cancer treatment. One problem of this treatment is the fact that a high percentage of tumor remains after the operation, since more residual remains, higher is the possibility of regeneration of the tumor.

The radio-guided surgery is a surgical technique developed to help the surgeon to perform a complete tumor resection. The radio-marked tracer is administered to the patient before the surgical operation and it is preferentially taken up by the tumor. During the operation, surgeon can search the residuals using a probe system that detects the tracer. Today it is a standard technique, but it is based on gamma emitting radio tracer (and so gamma probe). The drawback of using photons relies in the gamma’s high penetration power. The consequence of this is a high background from the nearby healthy tissue that have taken up small dose of the tracer. So the gamma probes can be used only for a limited numbers of tumors.

Our idea is to extend this technique to a large number of tumors by using beta minis radio tracers. Electrons have lower penetration power so we can achieve a higher spatial resolution. We have built a first prototype of beta minus probe, and tested it. Two are the points that guided us in the creation of the prototype: dimension and time

The probe must be handled by the surgeon; it must be compact (pen size). Surgeon must use it during operations, so we need an high efficiency in order to detect even small concentrations with low acquisition time. We have created a compact probe using as detector an active volume of para-therphenyl, a material with a very high light yield (30k gamma/MeV) linked by optical fibre to a photomultiplier. We have tested it and with the information acquired we have created different prototypes (crystal dimension and different read-out).

We have identified meningioma as the proof of principle and glioma and GEP-NETs as the first clinical trials to perform. We have performed ex-vivo tests on meningioma patients with the Ist. Neurologico Besta and the IEO of Milan, and we are planning more tests.

In the meanwhile, in collaboration with the Univ. Cattolica del Sacro Cuore, the Istituto Superiore di Sanita' and the Chemical departments of "La Sapienza" we are investigating the use and the development of new radio-tracers.

 Who:

V. Bocci, F. Collamati, R. Faccini, S. Morganti, A. Pepe, L. Recchia, A. Russomando, E. Solfaroli

Collaborations:

Outreach Presentation

video on small bowel GEP-NET

Press Releases:

Society for Nuclear Medicine and Molecular Imaging

INFN-Sapienza

Papers:

[14] Martelli C et al, Mass spectrometry characterization of DOTA-Nimotuzumab conjugate as precursor of an innovative beta(-) tracer suitable in radio-guided surgery, JOURNAL OF PHARMACEUTICAL AND BIOMEDICAL ANALYSIS 156, 8-15 (2018)

[13] Collamati F et al, Radioguided surgery with beta radiation: a novel application with Ga-68, Sci. Rep. 8, 16171 (2018)

[12] A. Russomando et al, The beta(-) radio-guided surgery: Method to estimate the minimum injectable activity from ex-vivo test, 2019 Phys. Med. 58, 114 

[11] L. Alunni Solestizi et al, Use of a CMOS Image Sensor for Beta-emitting radionuclides measurements., 2018 JINST 13 P07003

[10] S. Morganti et al, Position sensitive β− detector based on p-terphenyl scintillator for medical applications, 2018 JINST 13 P07001

[9] D. Carlotti et al, Use of bremsstrahlung radiation to identify hidden weak beta(-) sources: feasibility and possible use in radio-guided surgery, 2017 JINST 13 P11006

[8] C. Mancini-Terracciano et al, Feasibility of the -Radio-Guided Surgery with a Variety of Radio-Nuclides of Interest to Nuclear Medicine, 2017 Phys. Med. 43 127

[7] E. Solfaroli Camillocci et al, First ex vivo validation of a radioguided surgery technique with -radiation, 2016 Phys. Med. 32(9) 1139–1144 

[6] F. Collamati et al, Time evolution of DOTATOC uptake in Neuroendocrine Tumors in view of a possible application of Radio-guided Surgery with beta- Decays, J Nucl Med, 2015, vol 56, 1501-6

[5] Intraoperative beta- Detecting Probe For Radio-Guided Surgery in Tumour Resection,  A. Russomando et al, 2016 IEEE-TNS 63(5) 2533

[4] Polycrystalline para-terphenyl scintillator adopted in a beta- detecting probe for radio-guided surgery,  E Solfaroli Camillocci et al 2015 J. Phys.: Conf. Ser. 620 012009 doi:10.1088/1742-6596/620/1/012009

[3] Toward Radioguided Surgery with β- Decays: Uptake of a Somatostatin Analogue, DOTATOC, in Meningioma and High-Grade Glioma, J Nucl Med January 1, 2015 vol. 56 no. 1 3-8

[2] A novel radioguided surgery technique exploiting beta- decays,Sci. Rep. 4, 4401 (2014)

[1] Properties of para-terphenyl as detector for alpha, beta and gamma radiation, IEEE Transactions on Nuclear Science Volume 61, Issue 3, pp. 1483-1487
10.1109/TNS.2014.2322106

Patents:

• Italian patent application (RM2013A000053) entitled ‘‘Utilizzo di radiazione b- per la identificazione intraoperatoria di residui tumorali e la corrispondente sonda di rivelazione’’

• PCT patent application (PCT/IT2014/000025) entitled ‘‘Intraoperative detection of tumor residues using beta- radiation and corresponding probes’’
  

• Italian patent application (180321AE80) entitles "Radiofarmaco per utilizzo diagnostico terapeutico in medicina nucleare e medicina radioguidata"